■对于嗜铬细胞瘤术前给予苯氧基苄胺(PXB)后是否必须添加静脉补液尚无共识。这项研究的目的是研究PXB给药后放弃静脉容量扩张是否与术中血流动力学不稳定有关。
■83例嗜铬细胞瘤患者在泌尿外科接受手术治疗,邯郸第一医院,2014年10月至2022年7月。根据术中是否发生血流动力学不稳定分为血流动力学稳定组(HS组)和血流动力学不稳定组(HU组)。HS组51例,HU组32例。检查两组之间的数据差异,采用logistic回归分析术中血流动力学不稳定的危险因素。
■分析结果显示年龄差异无统计学意义,性别,肿瘤的位置,手术方法,体重指数(BMI)≥24kg/m2,血液和尿液儿茶酚胺检测结果,术前口服PXB,然后联合静脉扩张,两组患者合并高血压、糖尿病或冠心病的比例比较(P>0.05)。HS组的肿瘤大小小于HU组(5.3±1.9cmvs6.2±2.4cm,P=0.010)。多因素分析表明,肾上腺嗜铬细胞瘤患者术前接受α受体阻滞剂后放弃静脉容量扩张不是术中血流动力学不稳定的独立危险因素。只有肿瘤大小(P=0.025)是术中血流动力学不稳定的独立危险因素。
■一般术前静脉补液扩张的目的是防止肿瘤切除后低血压。在目前的研究中,我们指出,与单独口服PXB相比,使用α-受体阻滞剂PXB联合静脉容积扩张术治疗嗜铬细胞瘤并不能进一步降低术中血流动力学不稳定或术后并发症的风险.因此,我们的研究支持使用单一α-受体阻滞剂对嗜铬细胞瘤进行术前处理,PXB,就足够了。
There is no consensus on whether intravenous rehydration must be added after preoperative phenoxybenzamine (PXB) administration for pheochromocytoma. The aim of this study is to investigate whether abandonment of intravenous volume expansion after PXB administration is associated with intraoperative hemodynamic instability.
83 Patients with pheochromocytoma received surgical treatment in the Department of Urology, Handan First Hospital, between October 2014 and July 2022. All patients were subclassified into either the hemodynamic stability group (HS group) or the hemodynamic instability group (HU group) according to whether intraoperative hemodynamic instability occurred, with 51 cases in HS group and 32 cases in HU group. Differences in data between the two groups were examined, and the risk factors for intraoperative hemodynamic instability were analyzed using logistic regression.
The results of the analysis showed no statistically significant differences in age, sex, location of the tumor, surgical method, body mass index (BMI) ≥ 24 kg/m2, blood and urine catecholamine test results, preoperative oral PXB followed by combined intravenous volume expansion, proportion of patients with hypertension or diabetes mellitus or coronary heart disease between the two groups (P>0.05). The size of the tumor in the HS group was smaller than that in the HU group (5.3 ± 1.9 cm vs 6.2 ± 2.4 cm P=0.010). Multivariate analyses demonstrated that abandonment of intravenous volume expansion after preoperative receipt of α-blockers in patients with adrenal pheochromocytoma was not an independent risk factor for intraoperative hemodynamic instability. Only the tumor size (P=0.025) was an independent risk factor for intraoperative hemodynamic instability.
The purpose of general preoperative intravenous fluid expansion is to prevent hypotension after the tumor has been resected. In the current study, we indicated that preoperative management of pheochromocytomas using the α-blocker PXB in combination with intravenous volume expansion does not further reduce the risk of intraoperative hemodynamic instability or postoperative complications compared with oral PXB alone. Therefore, our study supports preoperative management of pheochromocytoma with a single α-blocker, PXB, as sufficient.